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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Elevated troponin is increasingly recognized as a marker of cardiac injury and poor outcomes in diverse disease states. It was hypothesized that patients with infective endocarditis (IE) and elevated cardiac troponin would have more extensive IE and worse clinical outcomes. Patients were enrolled as part of the International Collaboration on Endocarditis (ICE) prospective cohort study; analysis of these patients was done retrospectively. Data from 83 consecutively enrolled patients from a single center were evaluated. Cardiac troponin I (cTnI) was drawn for clinical indications and before any cardiac surgery in 51 of the 83 patients. Outcomes evaluated were hospital mortality, annular or myocardial abscess on the basis of echocardiography or surgery, and central nervous system events. Of 51 patients with cTnI drawn, 33 (65%) had elevated cTnI > or =0.1 mg/dl. There were no differences in age, gender, prosthetic valve IE, Staphylococcus aureus IE, or history of coronary artery disease, congestive heart failure, or diabetes mellitus between patients with and without cTnI elevations. Patients with elevated cTnI were less likely to have isolated right-sided IE and more likely to have left ventricular systolic dysfunction or renal dysfunction (p <0.05 for each). In conclusion, elevated cTnI was associated with the composite of death, abscess, and central nervous system events (p <0.001).
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PMID:Relation of troponin elevation to outcome in patients with infective endocarditis. 1847 61

Behcet's disease is a multisystem disorder and classified as "vasculitic syndrome with a wide variety of clinical manifestations." Cardiac involvement is very rare but can occur with different presentations including: pericarditis, cardiomyopathy, endocarditis, endomyocardial fibrosis, intracavitary thrombosis, and coronary artery disease. Great vessel involvement is more common. Recurrent Phlebitis, commonly involving large vessels (superior vena cava, inferior vena cava, hepatic veins) and cerebral veins are the sole presentation in this regard. Arterial involvement is expressed by aneurysm or pseudoaneurysmal formation. Due to the wide variety of cardiovascular manifestations and the resulting high mortality, cardiac surgeons should be familiar with this disease. In this paper we review the articles and introduce our four cases presenting with aneurysm of ascending aorta with free aortic insufficiency, aneurysm of descending aorta, pulmonary artery aneurysm, and pseudoaneurysm of aortic arch.
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PMID:Cardiac and great vessel involvement in "Behcet's disease". 1901 8

We report a complex case of peripheral vascular disease (PVD), coronary artery disease (CAD), and three prosthetic heart valves, who developed severe mitral regurgitation (MR) due to healed endocarditis. She was successfully managed with a hybrid approach utilizing percutaneous coronary intervention (PCI) followed by minimally invasive mitral valve surgery (MIMVS) through right minithoracotomy. This was the patient's fifth cardiac surgery and she was discharged home on the fourth postoperative day (POD).
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PMID:Hybrid percutaneous coronary intervention and minimally invasive reoperative mitral valve surgery. 1926 30

Systemic lupus erythematosus is a common chronic autoimmune disorder causing injury to many organ systems. Cardiac complications of lupus affect most parts of the heart. These include pericarditis, myocarditis, endocarditis and coronary artery disease. While many histopathological findings in lupus-related cardiac diseases are non-specific, there are a few important findings which pathologists should be aware of. This review provides pathological descriptions of these entities.
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PMID:Cardiac pathology of systemic lupus erythematosus. 1956 Dec 27

Infections have been recognized as significant causes of cardiac diseases for many decades. Various microorganisms have been implicated in the etiology of these diseases involving all classes of microbial agents. All components of the heart structure can be affected by infectious agents, i.e. pericardium, myocardium, endocardium, valves, autonomic nervous system, and some evidence of coronary arteries. A new breed of infections have evolved over the past three decades involving cardiac implants and this group of cardiac infectious complications will likely continue to increase in the future, as more mechanical devices are implanted in the growing ageing population. This article will review the progress made in the past decade on understanding the pathobiology of these infectious complications of the heart, through advances in genomics and proteomics, as well as potential novel approach for therapy.An up-to-date, state-of-the-art review and controversies will be outlined for the following conditions: (i) perimyocarditis; (ii) infective endocarditis; (iii) cardiac device infections; (iv) coronary artery disease and potential role of infections.
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PMID:New perspectives of infections in cardiovascular disease. 2043 49

During a period of 25 years (1979-2004), 24060 operations with extracorporeal circulation were performed. Of them 9536 (39.6%) were valvular procedures and 763 were combined with coronary bypass grafting. 4315 pts were operated (45.3% of valvular operations) because of mitral valve disease 5559 mitral valves were corrected, including multivalvular and combined procedures. Initially, mitral surgeries were predominant, but currently aortic valves are operated two times more frequently. In 85.5% of cases mitral valve replacement was necessary (with prosthetic valve), but 803 pts underwent reconstructive surgery (445 commissurotomies and 358 valvo/annuloplasties, including 135 implantations of annuloplasty rings). Additionally, 421 DeVega tricuspid valve annuloplasties were performed, and 15 tricuspid rings were implanted. Because of infective endocarditis 182 mitral valves were corrected, including the replacement of 78 infected prostheses. The pts age varied between 10 and 85. In 1980 the mean age was 40, but currently it has increased to 55, and the pts with coronary artery disease are approximately 10 years older. The general mortality among pts with ECC was 4.2% in 2003, and after valvular procedures 4%. The mortality after mitral valve replacement diminished from 12% to 4.5-5%, and after reconstructions was two times lower. The mortality among pts with endocarditis was 11.8%. Several characteristic trends were observed: increase of the number of elder pts, decrease of mitral valve procedures in comparison with aortic ones, more common coincidence of coronary artery disease, better preoperative status of the pts, and decrease of the operative risk.
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PMID:[Surgical treatment of mitral valve malformations--25 years of experience]. 2052 12

A best evidence topic was written according to a structured protocol. The question addressed was 'Is it safe to perform coronary angiography (CA) in acute endocarditis?' Three hundred and ninety-seven papers were found using the reported search, of which six represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, key results and limitations of these papers are tabulated. One of the papers is a case report, which reported a fatal vegetation embolism from an infected aortic valve into the left main coronary artery 14 h after angiography. The remaining five papers are cohort studies. Four of these studies were performed between 1970 and 1980 before the era of echocardiography and were aimed at quantifying the severity of valvular regurgitation. No embolic complications or dislodgement of vegetations occurred in any of the five studies (186 patients). Guidelines published by the European Society of Cardiology (ESC) in 2009 recommended CA in the context of infective endocarditis (IE) for men >40 years old, postmenopausal women, and patients with at least one cardiovascular risk factor or a history of coronary artery disease. Exceptions include patients with large aortic vegetations which may be dislodged during catheterisation, and when emergency surgery is necessary - 1) native aortic or mitral IE with severe acute regurgitation or valve obstruction, or prosthetic valve IE with severe prosthetic dysfunction (dehiscence or obstruction) causing refractory pulmonary oedema or cardiogenic shock; 2) native aortic, mitral, or prosthetic valve IE with fistula into a cardiac chamber or pericardium causing refractory pulmonary oedema or shock. This is reiterated by the guidelines on the management of valvular heart disease published by the ESC in 2007. From the findings of the six papers, it can be concluded that coronary angiography can be performed safely in IE and should be performed if deemed necessary, unless the patients are haemodynamically unstable requiring emergency surgery, or have large vegetations of the aortic valve. This is consistent with the ESC guidelines.
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PMID:Is it safe to perform coronary angiography during acute endocarditis? 2160 18

A 73-year-old man with history of coronary artery disease and bypass surgery, atrial fibrillation, and left lower lobe non-small cell lung cancer was admitted with recurrent pneumonia and was referred for transesophageal echocardiogram for suspected aortic valve endocarditis by transthoracic echocardiography. The patient had a history of radiation treatment for lung cancer 6 years ago. He had subsequently developed esophageal strictures requiring repeated dilatations, and eventually repeated esophageal stenting. Recurrent aspiration pneumonia led to the discovery of stent erosion into his trachea leading to tracheoesophageal fistula. A covered Y tracheal stent was placed to close the fistulous tract, but persistent aspiration was noted. The cross-sectional diameter of the esophageal stents was determined to be larger than the transesophageal echocardiography (TEE) probe. TEE was performed under fluoroscopy for added safety. The esophageal stent position was confirmed with fluoroscopy before and after the procedure and the TEE probe remained inside the distal stent in the midesophageal position during the entire procedure. Small mobile vegetation was seen on the right coronary cusp and the noncoronary cusp showed a smaller vegetation. The patient tolerated the procedure well and there were no complications. Infectious disease consultation was obtained and antibiotic regimen was modified accordingly. Although there are studies addressing the safety of TEE in patients with esophageal varices, to our knowledge, there is no report of TEE being performed in patients with esophageal or tracheoesophageal stents. This case illustrates that TEE may be performed in patients with esophageal stents under careful fluoroscopic guidance. (Echocardiography 2012;29:E5-E7).
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PMID:Fluoroscopically guided transesophageal echocardiogram in a patient with esophageal stents. 2198 95

A 79-year-old man with severe aortic stenosis, history of coronary artery disease and a recent hospitalization for sepsis presented at our institution following a syncope and angina at rest. Coronary angiography and aortography showed an aortic root abscess, causing left main coronary artery compression. This life-threatening complication of aortic valve endocarditis is rare and requires immediate surgical correction.
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PMID:Left main compression by an aortic root abscess. 2230 81

Coronary artery disease, one of the leading causes of worldwide adult mortality, is most commonly atherosclerotic in pathogenesis. Nonatherosclerotic etiologies are quite rare. In the latter category, infective arteritis or infective vasculitis of the coronary arteries is a very rare but well-recognized subtype, usually discovered at autopsy. In this article, we present the clinicopathologic necropsy data of 10 patients in whom infective coronary arteritis was the leading cause of death. Among the 10 cases, the male/female ratio was 6:4, and with the exception of a 2-year-old female child, all the other patients were adults with an age range of 26 to 59 years. Of the 10 cases, 6 had infective endocarditis along with history of rheumatic heart disease in 3 patients, whereas 2 other patients had strong clinical suspicion of bacteremia or septicemia. The remaining 2 cases had preexisting coronary atherosclerosis with a history of stent placement in 1 of them. All our cases showed on histopathology acute obliterative inflammatory infiltrate consisting mainly of neutrophils along with bacterial colonies (in most of them) involving the epicardial and intramural coronary arteries. To the best of our knowledge, this is the largest series of infective coronary arteritis to be reported in the world.
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PMID:Infective coronary arteritis: a pathological analysis at autopsy. 2283 81


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